Experts raise doubts over pop-up heart and stroke screening clinics

Medical experts say they have doubts over pop-up clinics that screen for heart attacks and strokes in a procedure that they say is not appropriate for people without any symptoms.

Case study: John Pinchen

In October last year, Mr Pinchen received a letter in the mail outlining the screening services.

He had the tests and an ultrasound on his abdomen revealed he had an aneurysm on his aorta.

The nurses told him of the diagnosis and that he needed to see his doctor.

His GP arranged for him to see a vein specialist and he had the aneurysm removed.

"If I had tossed that letter in the bin, the aneurysm could have burst," he said.

"I believe the screening saved my life."

He had a prior history of high blood pressure and had had a mild stroke.

But he says he is glad he went to the Screen for Life clinic.

"It was worth $190," he said.

Consumer authorities in two Australian states are looking into the clinics offered by Screen for Life.

The Screen for Life website says it offers fast, painless and affordable preventive health screening.

Medical director Professor Scott Kitchener says the clinics are run by registered nurses, with screenings performed by highly trained sonographers.

The results are reviewed by a cardiologist and are delivered to the patient within 21 days.

He says they have identified serious health problems in some patients.

"If there is a finding on the screening of concern then we discuss it with their GP. And occasionally I've even called vascular surgeons and cardiologists to further discuss the signals we've found on screening," he said.

Screen for Life offers a range of medical tests, including ultrasound of the carotid arteries.

However, medical experts such as Professor Paul Glasziou, director of the Centre for Research in evidence-based practice at Bond University, says the procedure is not appropriate for people without any symptoms.

"The ultrasound screens of the carotid artery, which is one of the screens that is being done, is generally not recommended," he said.

"The College of General Practitioners here doesn't recommend it, the US preventative task force doesn't recommend it for the general population."

The US preventative services task force is an independent US government panel that evaluates screening.

It estimates that doctors would need to screen more than 4,300 people with ultrasound and a follow-up magnetic resonance imaging testing to prevent a single stroke.

Professor Glasziou says there are some specific groups, such as people who have had a mini stroke, where it is really important to do ultrasound screening of carotid arteries.

"But as a general screening, it is not a particularly good idea. I personally don't have it and I wouldn't do it for my patients," he said.

"It is much more important that they just get the routine checks.

"'Do you smoke? What's your cholesterol? What's your blood pressure? Do you have diabetes?', And do those first.

"If there are any indications from those things then I may consider [those] in very high-risk groups getting that sort of ultrasound screening."

Company sources clients through list provider

Melbourne GP Dr Lorraine Baker from the Victorian branch of the Australian Medical Association says a number of her patients have received personally addressed letters and brochures about the screening service.

"One of my patients was an elderly woman who actually attended the clinic. She was happy with the service she received but she assumed that the reports would be sent directly to her GP in a timely way which did not happen," she said.

Dr Baker says while there is no actual harm in any of the tests, people are asked to pay as much as $200 out of their own pocket.

Case study: Pauline Smethurst

Pauline Smethurst received a brochure in the mail suggesting she attend the screening clinics to prevent having a stroke.

She went along to a mobile clinic run at a hall in her Melbourne area.

Three weeks later she was sent the findings.

"There was one result which showed I had a plaque build up in my arteries in the left side of my neck," she said.

Her GP sent her off for further tests, which gave her the all clear.

"It was a 10 per cent build up [in my carotid artery] which is quite normal for my age group," she said.

"I had been worried for three weeks."

The tests cost Ms Smethurst more than $200.

She says she would not undertake similar screening tests again.

The tests are not covered by Medicare or private health insurance and are usually conducted at RSL or sporting clubs.

Dr Baker says the tests are being performed in settings not under the usual control of a registered health organisation such as a general practice.

"There is no evidence on the documents or on the website of the bona fides of the people actually performing the tests," Dr Baker said.

The company says it sources names and addresses from an accredited list provider.

The only information they have about recipients is that they are aged over 50 and live in an area where the clinics are held.

A spokesperson for Screen for Life says the company does not know anything about anyone's medical details or know who their GPs are.

"The information is just names and addresses of people in the relevant locations and demographic groups. Lists are generated by reputable commercial providers in accordance with Privacy Principles and the Australian Direct Marketing Code of Conduct," the spokesman said.

A spokesperson for Screen for Life says Medicare will only rebate for the screening in the presence of symptoms.

"Unfortunately, stroke, vascular disease and osteoporosis are considered 'silent conditions' often until severe disease is present. Typically they can have no previous symptoms, or only subtle ones until a significant presentation with stroke, heart attack or fractures," the spokesman said.

"By offering a screening service, Screen for Life is providing health information to people and potentially [avoiding] a catastrophic health event. This screening system also helps to reduce the burden on GPs."

Screen for Life says it makes a concerted effort to contact only to those individuals at highest risk of vascular disease - those over the age of 50.

"Specifically providing screening services to this group is appropriate because they have the highest rate of cardiovascular disease which can be addressed and prevented from significant progression to conditions such as stroke," the spokesman said.

Occasionally, the company says it will screen younger people who have other known risk factors indicating their risk for vascular disease is higher than others of their age.

"Such other risk factors are the presence of a strong family history of vascular disease, pre-existing early vascular disease or the presence of diabetes," the spokesman said.

Consumer affairs investigates company

Consumer Affairs Victoria is now looking into the operations of the company.

New South Wales Fair Trading has also received a number of complaints about the clinics which it has passed on to the Health Care Complaints Commission for further investigation.

The Screen for Life brochure quotes statistics by the National Stroke Foundation, prompting the latter to issue a statement saying they do not endorse the company.

"It is a private organisation offering screening services for cardio vascular disease including stroke. While Screen for Life is referring to one of our stroke statistics, this should not be seen as an endorsement of its services," the statement from the Stroke Foundation said.

"If you are worried about cardiovascular disease, including stroke, the National Stroke Foundation recommends you visit your doctor and ask for an assessment. The National Stroke Foundation does not support medical tests that may be unnecessary."

American health authorities have raised concerns about similar community screening companies in the United States.

Stephen Weinberger, the chief executive of the American College of Physicians says a lot of population-based ultrasound screening has no clinical importance at all.

"Such screenings not only can raise healthcare costs but can also lead to additional testing that is harmful," he wrote in the Annals of Internal medicine journal in August.